[Spatio-temporal Evolution and Multi-scenario Simulation of Carbon Storage in Karst Regions of Central Guizhou Province：Taking Puding County as An Example].

Regional land use change is the main cause for the change in karst carbon storage. It is important to analyze the spatial and temporal evolution and future spatial distribution trends of carbon storage in typical counties in central Guizhou's karst region， such as Puding County， to improve regional carbon storage， optimize land ecological security patterns， and promote low-carbon sustainable urban development. The PLUS-InVEST model was coupled， based on the interpreted land use data and future land prediction， the spatial and temporal evolution characteristics of land use change and carbon storage in Puding County from 1973 to 2020 were inverted， and the spatial pattern evolution of land use and carbon storage change under different scenarios in 2060 were simulated and predicted. The results showed： ① from 1973 to 2020， the overall carbon storage in Puding County increased by 6.61×105 t， showing an upward trend. The spatial distribution showed a significant increase in the northeastern and southwestern parts of Puding County and a significant decrease in the south-central parts. The change was due to the increase in carbon storage in dryland to shrubland and forest land and the decrease in carbon storage in areas where paddy fields are converted to construction land. ② The land use change in Puding County in the historical period was mainly reflected in the continuous expansion of construction land and the increased fluctuation of the proportion of forest land and shrub forest land， and the change in land use in different scenarios projected in 2060 retained the change characteristics of the historical period. ③ In 2060， the carbon storage in Puding County under the scenarios of natural evolution， ecological protection， and economic development increased by 2.93×105， 5.40×105， and 1.11×105 t， respectively， compared with that in 2020. Of these， the increase in ecological protection scenarios was the most significant， with the transfer of dryland to shrubland being the main reason for the increase in regional carbon sequestration capacity. These results can serve as a scientific reference for land use management decisions and the formulation of emission reduction and sink increase policies in Puding County. The future land use planning of karst areas should be guided by the goal of "carbon neutrality" in 2060， take appropriate ecological protection measures， strictly control the rapid expansion of construction land to paddy fields， optimize the land use structure， and effectively improve the level of regional carbon storage.

Prevalence of thalassemia-carrier couples and fertility risk assessment.

Thalassemia is a highly prevalent hematologic disease in Guizhou, China. This study aimed to determine the epidemiological characteristics of thalassemia in couples at childbearing age and assess the neonatal risk of thalassemia in this subpopulation. A cohort of 4481 couples at childbearing age were recruited for thalassemia carrier screening by both traditional hematological tests and next-generation sequencing. Of them, 1314 (14.66%) thalassemia carriers were identified, including 857 (9.76%) α-thalassemia, 391 (4.36%) ß-thalassemia, and 48 (0.54%) composite α and ß-thalassemia. A total of 12 α-globin gene alterations and 16 ß-globin mutations were detected, including four novel thalassemia mutations. SEA was the most common α-thalassemia genotype (26.86%), CD41-42 the most common ß-thalassemia genotype (36.57%), and αα/- α3.7 + CD41-42 the most common composite α- and ß-thalassemia genotype (18.75%). Ethnically, the Zhuang had the highest rate of thalassemia gene carriers among the ethnic groups. Geographically, Qiannan had the highest rate of thalassemia gene carriers. In addition, 38 of the 48 couples with composite α- and ß-thalassemia were high-risk thalassemia carriers, and 4 carrying the -SEA/αα gene needed fertility guidance.

Assessment of Effective Antimicrobial Regimens and Mortality-Related Risk Factors for Bloodstream Infections Caused by Carbapenem-Resistant Acinetobacter baumannii.

Objective: This study aimed to determine the clinical features, risk factors, and effective antimicrobial therapy for Carbapenem-resistant Acinetobacter baumannii (CRAB) bloodstream infection (BSI). Methods: This was a retrospective analysis of data from patients with CRAB bacteremia in a Chinese tertiary hospital between January 2012 and October 2021. Risk factors, predictors of 30-day mortality, and effective antimicrobial therapy for CRAB BSI were identified using logistic and cox regression analyses. Results: Data from 276 patients with Acinetobacter baumannii (AB) BSI were included, of whom 157 (56.9%) had CRAB BSI. The risk factors that were significantly associated with CRAB BSI included previous intensive care unit (ICU) stay (P < 0.001), immunocompromised status (P < 0.001), cephalosporin use (P = 0.014), and fluoroquinolone use (P = 0.007). The 30-day mortality of the CRAB BSI group was 49.7% (78/157). ICU stay after BSI (P = 0.047), sequential organ failure assessment (SOFA) score ≥10 (P < 0.001), and multiple organ failure (MOF) (P = 0.037) were independent predictors of 30-day mortality. Among antibiotic strategies for the treatment of patients with CRAB BSI, we found that definitive regimens containing cefoperazone/sulbactam were superior to those without cefoperazone/sulbactam in reducing the 30-day mortality rate (25.4% vs 53.4%, P = 0.005). After propensity score matching, we observed a significant increase in the 30-day mortality (77.8%vs 33.3%, P = 0.036) in patients receiving tigecycline monotherapy compared to those receiving cefoperazone/sulbactam monotherapy. The mortality rate of patients receiving tigecycline with cefoperazone/sulbactam was also higher than that of patients receiving cefoperazone-sulbactam monotherapy; however, the difference was not significant (28.6%vs 19.0%, P = 0.375). Conclusion: The severity of patient conditions was significantly associated with mortality in patients with CRAB BSI. Those Patients treated with cefoperazone/sulbactam had better clinical prognoses, and tigecycline should be used with caution.

Measurement of Tourism-Related CO2 Emission and the Factors Influencing Low-Carbon Behavior of Tourists: Evidence from Protected Areas in China.

In the fight against climate change, future policy directions in the transition toward a green travel- and tourism-based economy include improving tourism-derived CO2 emission levels and guiding individual low-carbon behavior. In China, people tend to engage in outdoor adventure travel and cultural tourism in natural areas. However, limited information is available on the empirical evaluation of energy use and the CO2 emissions associated with tourism in protected areas. The present study used a life cycle assessment to explore energy use and CO2 emissions due to tourism and identify the factors driving low-carbon behavior. To these ends, survey data for the protected areas of the Qinling Mountains from 2014 to 2019 were used. The results showed that energy use and CO2 emissions in various tourism sectors steadily increased from 2014 to 2019, primarily because of an increase in transportation activity. This study used data derived from the calculation of CO2 emissions per tourist per trip to identify the various factors jointly contributing to the low-carbon behavior of tourists. These included a low-carbon attitude, low-carbon knowledge, environmental education, and policy reward. The broader implications of this study are that several emission reduction policy options are available to address the challenges inherent in sustainable tourism development and that these policies may be selected according to specific conditions. The low-carbon transformation of recreational facilities at travel destinations, policy rewards, and environmental education can regulate tourist behavior, holding the key to sustainable tourism development in protected areas.

Diffusion-weighted imaging-based radiomics in epithelial ovarian tumors: Assessment of histologic subtype.

Background: Epithelial ovarian tumors (EOTs) are a group of heterogeneous neoplasms. It is importance to preoperatively differentiate the histologic subtypes of EOTs. Our study aims to investigate the potential of radiomics signatures based on diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) maps for categorizing EOTs. Methods: This retrospectively enrolled 146 EOTs patients [34 with borderline EOT(BEOT), 30 with type I and 82 with type II epithelial ovarian cancer (EOC)]. A total of 390 radiomics features were extracted from DWI and ADC maps. Subsequently, the LASSO algorithm was used to reduce the feature dimensions. A radiomics signature was established using multivariable logistic regression method with 3-fold cross-validation and repeated 50 times. Patients with bilateral lesions were included in the validation cohort and a heuristic selection method was established to select the tumor with maximum probability for final consideration. A nomogram incorporating the radiomics signature and clinical characteristics was also developed. Receiver operator characteristic, decision curve analysis (DCA), and net reclassification index (NRI) were applied to compare the diagnostic performance and clinical net benefit of predictive model. Results: For distinguishing BEOT from EOC, the radiomics signature and nomogram showed more favorable discrimination than the clinical model (0.915 vs. 0.852 and 0.954 vs. 0.852, respectively) in the training cohort. In classifying early-stage type I and type II EOC, the radiomics signature exhibited superior diagnostic performance over the clinical model (AUC 0.905 vs. 0.735). The diagnostic efficacy of the nomogram was the same as that of the radiomics model with NRI value of -0.1591 (P = 0.7268). DCA also showed that the radiomics model and combined model had higher net benefits than the clinical model. Conclusion: Radiomics analysis based on DWI, and ADC maps serve as an effective quantitative approach to categorize EOTs.

[Pollution and Carbon Reduction Effect of OFDI in China and Its Mechanism].

Under the "Going out" strategy and the Belt and Road Initiatives, the trade in goods and services and flow of production factors between China and the rest of the world have become more frequent, and the total amount of outward foreign direct investment (OFDI) is considerable and growing significantly. Therefore, along with the extensive economic growth and the substantial growth of foreign investment, the environmental impact of OFDI has become noteworthy. Here, through theoretical analysis and logical deduction, three possible pathways of the impact of OFDI in China on the environment were presented as hypotheses, which included the industrial structure, the technological innovation progress, and the economic-scale expansion. Using Chinese provincial data from 2004 to 2019, an environmental load index including main environmental pollutant emissions and carbon emissions was constructed. Taking this as the dependent variable, an intermediary effect method was constructed to analyze the home pollution and carbon reduction effect and the influence mechanism of OFDI in China. The results showed that ① OFDI in China reduced the environmental load, and each 1% increase in OFDI reduced the environmental load by 0.051%-0.076%. ② The OFDI in China reduced the environmental load by advancing the industrial structure and technological innovation progress, and a 1% increase in OFDI resulted in a 0.060% and 0.006% reduction in environmental load through their indirect effects, respectively, whereas OFDI increased the environmental load by 0.009% through the path of economic-scale expansion. The contributions of leading environmental load changes mediated by advancing industrial structure, technological innovation progress, and economic-scale expansion were 65.9%-84.5%, 6.6%-8.5%, and -12.7%- -9.9%, respectively, and the contribution of OFDI directly driving the environmental load to change was 19.7%-37.4%. Based on this, policy recommendations, including promoting Chinese enterprises and capital going abroad, encouraging relatively disadvantaged domestic industries to explore foreign markets, strengthening reverse technology spillover effects, and forming a sustainable low-carbon development mode, have been proposed.

A comparative study of stage characteristics and factorial decomposition of CO2 emissions between China and the USA.

CO2 contributes a lot to the greenhouse effect. The total CO2 emissions of the two countries, China and the USA, as the world's top two economies, have exceeded 40% of the total global carbon emissions. In this context, the exploration of the evolution of carbon emissions from energy consumption in China and the USA and the comparison of the characteristics of carbon emission drivers in different periods play a significant role in the policy formulation and climate change cooperation between China and the USA. In this study, the BP structural breakpoint test was used to divide the carbon emission stages of China and the USA from 1970 to 2019. The generalized Divisia index model (GDIM) was developed to decompose the growth of carbon emissions in China and the USA into eight items, GDP, carbon intensity of GDP, energy use, carbon intensity of energy, population, carbon emissions per capita, GDP per capita, and energy intensity, and to analyze the characteristics and cumulative contribution of carbon emission drivers at each stage. Based on the stage and cumulative characteristics of carbon emissions between China and the USA, the USA should take the initiative to assume the legal responsibility of carbon emissions and further deepen the cooperation with other countries in the field of climate change. China should transform the economic growth mode, optimize the energy structure, and improve the efficiency of resource utilization to help achieve the peaking carbon emissions and the carbon neutrality smoothly.

A Novel Approach for Developing Efficient and Convenient Short Assessments to Approximate a Long Assessment.

This paper describes a novel Long to Short approach that uses machine learning to develop efficient and convenient short assessments to approximate a long assessment. This approach is applicable to any assessments used to assess people's behaviors, opinions, attitudes, mental and physical states, traits, aptitudes, abilities, and mastery of a subject matter. We demonstrated the Long to Short approach on the Depression Anxiety Stress Scale (DASS-42) for assessing anxiety levels in adults. We first obtained data for the original assessment from a large sample of participants. We then derived the total scores from participants' responses to all items of the long assessment as the ground truths. Next, we used feature selection techniques to select participants' responses to a subset of items of the long assessment to predict the ground truths accurately. We then trained machine learning models that uses the minimal number of items needed to achieve the prediction accuracy similar to that when the responses to all items of the whole long assessment are used. We generated all possible combinations of minimal number of items to create multiple short assessments of similar predictive accuracies for use if the short assessment is to be done repeatedly. Finally, we implemented the short anxiety assessments in a web application for convenient use with any future participant of the assessment.

Can Aspirin Use Be Associated With the Risk or Prognosis of Bladder Cancer? A Case-Control Study and Meta-analytic Assessment.

Aspirin, widely used to prevent cardiovascular disease, had been linked to the incidence of bladder cancer (BCa). Existing studies focusing on Chinese populations are relatively rare, especially for Northeast China. Meanwhile, relevant studies on the effects of aspirin on the occurrence or prognosis of BCa are inconsistent or even controversial. First, in the case control study, logistic regression analysis was used to investigate the association between aspirin intake and risk of BCa including 1121 patients with BCa and the 2242 controls. Subsequently, Kaplan-Meier curve and Cox regression analyses were applied to explore the association between aspirin intake and clinicopathological factors which may predict overall survival (OS) and recurrence-free survival (RFS) of BCa patients. Finally, we quantificationally combined the results with those from the published literature evaluating aspirin intake and its effects on the occurrence, outcome of surgery and prognosis of BCa by meta-analysis up to May 1, 2021.Our case-control study demonstrated that the regular use of aspirin was not associated with a reduced incidence of BCa (P=0.175). Stratified analyses of sex showed that aspirin intake did not lead to a lower risk of BCa in female patients (P=0.063). However, the male population who regularly took aspirin had a lower incidence of BCa (OR=0.748, 95% CI= 0.584-0.958, P=0.021). Subgroup analyses stratified by smoking found a significant reduction in the risk of BCa in current smokers with aspirin intake (OR=0.522, 95% CI=0.342-0.797, P=0.002). In terms of prognosis of BCa, patients with a history of aspirin intake did not had a markedly longer OS or RFS than those with no history of aspirin intake by Kaplan-Meier curves. Stratified analysis by sex showed no correlation between aspirin intake and the recurrence or survival of BCa for either male or female patients. However, in people younger than 68, aspirin intake seemed to have prolonged effects for overall survival (HR=3.876; 95% CI=1.326-11.325, P=0.019). Then, we performed a meta-analysis and the combined results from 19 articles and our study involving more than 39524 BCa cases indicated that aspirin intake was not associated with the occurrence of BCa (P=0.671). Subgroup analysis by whether regular use of aspirin, by the mean duration of use of aspirin, by sex, by smoking exposure, by research region and by study type also supported the above results. In terms of the impact of aspirin intake on the prognosis of patients with BCa, 11 articles and our study involving 8825 BCa cases were eligible. The combined results showed that patients with aspirin intake did not have significantly influence on survival, recurrence, progression and metastasis than those without aspirin intake. On the whole, both our retrospective study and literature meta-analysis suggested a lack of a strong relevant association between the use of aspirin and the incidence or prognosis of BCa. Thus, additional long-term follow-up prospective research is warranted to clarify the association of aspirin with BCa incidence and prognosis.

[Spatial Distribution Characteristics, Source Apportionment, and Risk Assessment of Topsoil PAHs in the Core Area of the Ningdong Energy and Chemical Industry Base].

In order to evaluate the pollution of polycyclic aromatic hydrocarbons (PAHs) in the topsoil of the core area of the Ningdong Energy and Chemical Industry Base, 146 representative topsoil samples were collected using the grid method and the contents of 16 priority PAHs were analyzed. The results showed that the content of ΣPAHs in topsoil ranged from ND to 123.12 mg·kg-1 with an average of 10.19 mg·kg-1. There were three high PAHs distribution areas in the northwest, southwest, and east of the core area. The source apportionment showed that the sources of PAHs in the Ningdong base were complex, and the main pollution sources were petroleum, coal combustion, traffic, and gasoline, which contributed 39.4%, 33.3%, 19.2%, and 8.1% to the total PAHs sources, respectively. The ecological risk assessment of the quality basis and quality standard method showed that the ecological impact of PAHs in the core area was slight and the possibility of negative ecological effects was low. The results of the health risk assessment showed that the order of exposure of the topsoil PAHs was skin contact > swallowing > respiratory inhalation, and the topsoil PAHs in the core area of the Ningdong base posed no potential carcinogenic risk to people of different ages.

Automatic quality assessment for 2D fetal sonographic standard plane based on multitask learning.

ABSTRACT: The quality control of fetal sonographic (FS) images is essential for the correct biometric measurements and fetal anomaly diagnosis. However, quality control requires professional sonographers to perform and is often labor-intensive. To solve this problem, we propose an automatic image quality assessment scheme based on multitask learning to assist in FS image quality control. An essential criterion for FS image quality control is that all the essential anatomical structures in the section should appear full and remarkable with a clear boundary. Therefore, our scheme aims to identify those essential anatomical structures to judge whether an FS image is the standard image, which is achieved by 3 convolutional neural networks. The Feature Extraction Network aims to extract deep level features of FS images. Based on the extracted features, the Class Prediction Network determines whether the structure meets the standard and Region Proposal Network identifies its position. The scheme has been applied to 3 types of fetal sections, which are the head, abdominal, and heart. The experimental results show that our method can make a quality assessment of an FS image within less a second. Also, our method achieves competitive performance in both the segmentation and diagnosis compared with state-of-the-art methods.

Preliminary assessment of video-based blood pressure measurement according to ANSI/AAMI/ISO81060-2: 2013 guideline accuracy criteria: Anura smartphone app with transdermal optimal imaging technology.

OBJECTIVE: A new smartphone app called Anura can measure blood pressure (BP) any time and any place without cuffs or special equipment from video of the face. This study assessed its accuracy in close conformity with the American National Standards Institute/Association for the Advancement of Medical Instrumentation/International Organization for Standardization (ANSI/AAMI/ISO) 81060-2:2013 standard for BP measurement devices. METHODS: We validated Anura in reference to auscultation using a mercury sphygmomanometer and then assessed accuracy against the two accuracy criteria described in the guideline (n = 85 subjects; three measurement pairs per subject). RESULTS: The mean difference between the Anura measurement and its paired auscultatory reference measurement across all 255 measurement pairs was -0.4 ± 6.7 mmHg for systolic blood pressure (SBP) and 1.2 ± 7.0 mmHg for diastolic blood pressure (DBP). Both are within the acceptable limit of 5 ± 8 mmHg and thus satisfy accuracy criterion 1. When mean differences are averaged for each subject, the mean across all 85 subjects is -0.4 ± 5.8 mmHg for SBP and 1.2 ± 6.7 mmHg for DBP. Both are within acceptable limits (based on the mean difference) and thus satisfy accuracy criterion 2. CONCLUSIONS: Anura meets ANSI/AAMI/ISO 81060-2:2013 standard with respect to BP measurement accuracy. As the ANSI/AAMI/ISO 81060-2:2013 standard has not been developed for cuffless devices, further research assessing additional accuracy issues specific to such devices is needed.

A Predictive Model Offor Attention Deficit Hyperactivity Disorder Based on Clinical Assessment Tools.

BACKGROUND: At present, clinicians diagnose that the clinical diagnosis of attention deficit hyperactivity disorder (ADHD) in children is mainly on the basis of the information provided by their parents, the behaviour of children in clinical clinics and the assessments of clinical rating scales and neuropsychological tests. Notably, no unified standard exists currently for analysing the results of various measurement tools for diagnosing ADHD. Therefore, clinicians interpret the results of clinical rating scales and neuropsychological tests entirely based on their clinical experience. METHODS AND SUBJECTS: To provide guidance for clinicians on how to analyse the results of various clinical assessment tools when diagnosing ADHD, this study assessed children with ADHD and children in the control group using two clinical assessment scales-parent rating scale (PSQ) and Child Behavior Checklist (CBCL)-and one neuropsychological test (Integrated Visual and Auditory Continuous Performance Testing). The two-sample t-test (FDR correction) screened the parameters of the three assessment tools with significant inter-group differences. LibSVM was used to establish a classification prediction model for analysing the accuracy of ADHD prediction using parameters of the three assessment tools and weight values of each parameter for classification prediction. RESULTS: A total of 19 parameters (16 from clinical rating scales, 3 from neuropsychological tests) with significant inter-group differences were screened. The accuracy of classification modelling was higher for the clinical rating scales (61.635%) than for the neuropsychological test (59.784%), whereas the accuracy of classification modelling was higher for the clinical rating scales combined with the neuropsychological test (70.440%) than for the former two parameters alone. The three parameters with the highest weight values were learning problem (0.731), hyperactivity/impulsivity (0.676) and activity capacity (0.569). The three parameters with the lowest weight values are integrated control force (0.028), visual attention (0.028) and integrated attention (0.034). CONCLUSION: Our study findings indicate that the diagnosis of ADHD should be based on multidimensional assessment. For a more accurate diagnosis of ADHD, assessments and that more assessment parameters should be developed on the basis of different dimensions of physiology or psychology in the future to obtain a more accurate diagnosis of ADHD. Furthermore, the predictive model for ADHD may improve our understanding and help in optimisation of the treatment of such a condition.

Assessment of mental workload based on multi-physiological signals.

BACKGROUND: Mental workload is one of the contributing factors to human errors in road accidents or other potentially adverse incidents. OBJECTIVE: This research probes the effects of mental workload on the electroencephalographic (EEG) and electrocardiogram (ECG) of subjects in visual monitoring tasks, based on which a comprehensive evaluation model for mental workload is established effectively. METHODS: Three degrees of mental workload were obtained by monitoring tasks with different levels of difficulty. 20 healthy subjects were selected to take part in the research. RESULTS: The subjective scores showed a significant increase with the increase of task difficulty, meanwhile the reaction time (RT) increased and the accuracy decreased significantly, which proved the validity of three degrees of mental workload induced. For the EEG parameters, a significant decrease of θ energy was found in Frontal, Parietal and Occipital with the increase of level of mental workload, as well as a significant decrease of α energy in Frontal, Central and Occipital, meanwhile a significant increase of ß energy occurred in Frontal and Occipital. There was a significant decrease of α/θ in Occipital, and significant increases of θ/ß and (α+ß)/θ in Frontal, Central and Occipital, meanwhile (α+θ)/ß and WPE decreased significantly in Frontal and Occipital. Among the ECG parameters, it was shown that Mean RR, RMSSD, HF_norm and SampEn decreased significantly with the increase of task difficulty, while LF_norm and LF/HF showed significant increases. These EEG indictors in Occipital and ECG indictors were chosen and constituted a multidimensional original sample. Principal Component Analysis (PCA) was used to extract the principal elements and decreased the dimension of sample space in order to simplify the calculation, based on which an effective classification model with accuracy of 80% was achieved by support vector machine (SVM). CONCLUSION: This study demonstrates that the proposed algorithm can be applied to mental workload monitoring.

A virtual reality application for assessment for attention deficit hyperactivity disorder in school-aged children.

Background and objective: The development of objective assessment tools for attention deficit hyperactivity disorder (ADHD) has become a hot research topic in recent years. This study was conducted to explore the feasibility and availability of virtual reality (VR) for evaluating symptoms of ADHD. Methods: School-aged children were recruited. The children with ADHD or without ADHD were assigned into the ADHD group or Control group, respectively. They were all evaluated using the Conners' Parent Rating Scale (CPRS), Child Behavior Checklist (CBCL), Integrated Visual and Auditory Continuous Performance Test (IVA-CPT), and a VR test. Results: The correct items, incorrect items, and the accuracy rate of the VR test of the children with ADHD were significantly different with those of the children in the Control group. The correct items, incorrect items, total time, and accuracy of the VR test were significantly correlated with the scores of IVA-CPT (auditory attention and visual attention), CPRS (impulsion/hyperactivity and ADHD index), and CBCL (attention problems and social problems), respectively. Discussion: The results supported the discriminant validity of the VR test for evaluating ADHD in school-age children suffering from learning problems. The VR test results are associated with the commonly used clinical measurements results. A VR test is interesting for children and therefore it attracts them to complete the test; whilst at the same time, it can also effectively evaluate ADHD symptoms.

Comorbidity Burden of Dementia: A Hospital-Based Retrospective Study from 2003 to 2012 in Seven Cities in China.

Dementia is increasing dramatically and imposes a huge burden on society. To date, there is a lack of data on the health status of patients with dementia in China. In an attempt to investigate the comorbidity burden of dementia patients in China at the national level, we enrolled 2,938 patients with Alzheimer's disease (AD), vascular dementia (VaD), or other types of dementia, who were admitted to tertiary hospitals in seven regions of China from January 2003 to December 2012. The Charlson Comorbidity Index (CCI) was used to evaluate the comorbidity burden of the patients with dementia. Among these patients, 53.4% had AD, 26.3% had VaD, and 20.3% had other types of dementia. The CCI was 3.0 ± 1.9 for all patients, 3.4 ± 1.8 for those with VaD, and 3.0 ± 2.1 for those with AD. The CCI increased with age in all patients, and the length of hospital stay and daily expenses rose with age and CCI. Males had a higher CCI and a longer stay than females. Moreover, patients admitted in the last 5 years of the study had a higher CCI than those admitted in the first 5 years. We found that the comorbidity burden of patients with dementia is heavy. These findings provide a better understanding of the overall health status of dementia patients, and help to increase the awareness of clinicians and policy-makers to improve medical care for patients.

Comorbidity burden of patients with Parkinson's disease and Parkinsonism between 2003 and 2012: A multicentre, nationwide, retrospective study in China.

Parkinson's disease (PD) and Parkinsonism are common neurodegenerative disorders with continuously increasing prevalence, causing high global burdens. However, data concerning the comorbidity burden of patients with PD or Parkinsonism in China are lacking. To investigate the health condition and comorbidity burden, a total of 3367 PD and 823 Parkinsonism patients were included from seven tertiary hospitals in seven cities across China from 2003 to 2012. Their comorbidity burden was collected and quantified by the Elixhauser Comorbidity Index (ECI) and Charlson Comorbidity Index (CCI). The comorbidity spectra differed between PD and Parkinsonism patients. Compared with PD patients, Parkinsonism patients were older (69.8 ± 11.5 vs. 67.9 ± 11.4, P < 0.001); had a higher comorbidity burden, including ECI (1.1 ± 1.2 vs. 1.0 ± 1.2, P < 0.001) and CCI (1.3 ± 1.6 vs. 1.1 ± 1.5, P < 0.001); and had higher hospitalization expenses. The ECI (1.1 ± 1.3 vs. 0.9 ± 1.1, P < 0.001) and CCI (1.3 ± 1.6 vs. 0.9 ± 1.2, P < 0.001) were higher in males than in females. The average length of stay and daily hospitalization expenses increased with age, as did ECI and CCI. This is the first study to report the disease burden of Chinese PD and Parkinsonism patients. It provides useful information to better understand their health status, and to raise the awareness of clinicians for providing better health care.

The impact of predisposing, enabling, and need factors in utilization of health services among rural residents in Guangxi, China.

BACKGROUND: Healthcare in China has significantly improved, meanwhile many  socio-economic risk factors and health conditions factors affect accessibility and utilization of health services in rural areas. Inequity of health service in China needs to  be estimated and reduced. Andersen behavioral model is useful to assess the association of health service utilization with predisposing, enabling, and need factors. METHODS: A survey was conducted among 4634 residents of 897 households in 2012. Logistic regression analysis was performed to explore the association of predisposing (age, gender, marital status, ethnicity and family size), enabling (education level, travel time to the nearest health facility, medical expense per capita, and health insurance coverage), and need factors (chronic disease) with the utilization of health services (i.e. physician visit and hospitalization). RESULTS: We observed a significant association between need factor (chronic diseases) and health service unitization, after adjusting for all predisposing and enabling factors (physician visits: odds ratio (OR) = 5.87, 95 % confidence interval (CI) = 4.71-7.32; hospitalization: OR = 4.04, 95 % CI = 2.90-5.61, respectively). In addition, age, gender, marital status, family size and education level were significant predictors of health service utilization. The travel time to the nearest health facility was associated with the utilization of physician visits, and expenditure on healthcare was a hindering factor of hospitalization. CONCLUSIONS: The predisposing and enabling factors had a minor impact on health service utilization, while the need factor was a dominant predictor of health service utilization among rural residents in China.

Thiazole orange as a fluorescent probe: Label-free and selective detection of silver ions based on the structural change of i-motif DNA at neutral pH.

Silver ions have been widely applied to many fields and have harmful effects on environments and human health. Herein, a label-free optical sensor for Ag(+) detection is constructed based on thiazole orange (TO) as a fluorescent probe for the recognition of i-motif DNA structure change at neutral pH. Ag(+) can fold a C-rich single stranded DNA sequence into i-motif DNA structure at neutral pH and that folding is reversible by chelation with cysteine (Cys). The DNA folding process can be indicated by the fluorescence change of TO, which is non-fluorescent in free molecule state and emits strong fluorescence after the incorporation with i-motif DNA. Thus, a rapid, sensitive, and selective method for the detection of Ag(+) and Cys is developed with a detection limit of 17 and 280nM, respectively. It is worth noting that the mechanism underlying the increase of the fluorescence of thiazole orange in the presence of i-motif structure is explained. Moreover, a fluorescent DNA logic gate is successfully designed based on the Ag(+)/Cys-mediated reversible fluorescence changes. The proposed detection strategy is label-free and economical. In addition, this system shows a great promise for i-motif/TO complex to analyze Ag(+) in the real samples.

Long-term evaluation of the controlled pressure method for assessment of the vapor intrusion pathway.

Vapor intrusion (VI) investigations often require sampling of indoor air for evaluating occupant risks, but can be confounded by temporal variability and the presence of indoor sources. Controlled pressure methods (CPM) have been proposed as an alternative, but temporal variability of CPM results and whether they are indicative of impacts under natural conditions have not been rigorously investigated. This study is the first involving a long-term CPM test at a house having a multiyear high temporal resolution indoor air data set under natural conditions. Key observations include (a) CPM results exhibited low temporal variability, (b) false-negative results were not obtained, (c) the indoor air concentrations were similar to the maximum concentrations under natural conditions, and (d) results exceeded long-term average concentrations and emission rates under natural conditions by 1-2 orders of magnitude. Thus, the CPM results were a reliable indicator of VI occurrence and worst-case exposure regardless of day or time of year of the CPM test.